Should I be concerned yet?

[hollyj]

I cracked my humeral head on 3 sides of the ball part, like a “c” shape, on Dec 28 and after x-rays was given a sling and swathe as it is not displaced. I saw an orthopaedic doctor on Jan 2 who said I should continue with the sling and swathe but then start light motion exercises 3 weeks from then – which is about now.

I’m a little worried as I have now started to try to move it, but when I try to lift my arm out to the side it pops at the shoulder and is very painful. It hurts when I try to extend my elbow but sort of a muscle ache which I would expect after a month in one position and I had a lot of bruising on my bicep. My movement is getting better every day but am I expecting too much too soon? I’ve read it can take up to 6 weeks for a fracture to mend?

I DON’T have INSURANCE or much money so am reluctant to go back to the doctor, pay for more x-rays and consultation if I’m just going to be told its too soon and to give it more time.

Any advice would be much appreciated I have electronic copies of my x-rays.

Im 27 years old, non- smoker, in good shape and have been maintaining a healthy diet with extra calcium and vitamins since the accident

Thank you

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[MrPhysio+]

Hello HollyJ,
Sorry to hear of your shoulder fracture. It is early days and you are correct to state that immobilisation will increase symptoms when you try to move. The forces required to cause the type of fracture you have are significant with a high liklihood that soft tissue damage will have occurred as well as bone damage. X-Rays are insufficient to diagnose the soft tissue damage - ultrasound and MRI are better. It is understood that your budget may preclude such scans. The Orthopaedic Specialist is probably waiting until bony repair is more complete, swelling has subsided and then assess the next step dependent upon your symptoms at the 6 to 8 week point. Exercises at the 3 to 4 week point could have begun eg letting the arm hang down and making very small swing and rotational movements (pendular exercise). Dependent upon pain and medication cover, such exercise may even be started a little sooner - depends upon how stable the fractured piece of bone is - with weaning off the sling as tolerated.
Often, night pain is eased significantly by specific taping of the joint (slings do not work at night).

The way your arm was originally injured can provide clues to the type of damage sustained. Can you describe the injury?

Your long head of bicep tendon may be damaged, although bruising into the bicep is common post fracture of the humeral head. Severe bruising around the shoulder then immobilisation increases the chance of a frozen shoulder, where the fibrous bag around the joint sticks to itself restricting movement and causing pain. It is also possible that the cartilage joint labrum (extension of the socket that makes it deeper for stability) can be torn or split. Small pieces of bone can be in the joint from the fracture, irritating the soft tissue causing pain and restriction.
All the above is speculation.

Shoulders are always very painful following injury. It is important to begin movement as early as medically permitted and to use as much pain medication as needed to allow the movement. Anti inflammatory medication, if you are able to take such medication, can also be helpful.

Your good fitness, general health and non smoking status give you an advantage in the healing stakes. I suggest that you see a physical therapist for assessment.
Let me know how you get on or if you have further questions.
Cheers,
MrPhysio+

[theshoulderguy]

Hi there, I would be interested in seeing the X-rays HollyJ.

See if you can attach them.

Will comment after viewing them if you like?

Cheers